NURS 317 Unit 1 Chapter 33 Path Point Questions Flashcards
A client admitted with acute pyelonephritis has shaking chills and acute pain. What other clinical manifestations will the nurse likely assess for this diagnosis? Select all that apply.
A) Pale skin and dry mucous membranes
B) Frequency, urgency, and dysuria
C) Moderate to high fever
D) Shallow breathing and expiratory wheezes
E) Change in level of consciousness and hallucinations
B) Frequency, urgency, and dysuria
C) Moderate to high fever
Rationale:The onset of acute pyelonephritis is usually abrupt, with shaking chills, moderate to high fever, and a constant ache in the loin area of the back that is unilateral or bilateral. Lower urinary tract symptoms, including dysuria, frequency, and urgency, also are common. It is not associated with expiratory wheezes, hallucinations, or dry mucous membranes
The nurse is evaluating the urinalysis results of a client presenting with polyuria and lower abdominal pain due to a suspected urinary tract infection. Which finding should the nurse expect?
A) Solid formations
B) Positive glucose
C) Increased nitrates
D) Specific gravity of 1.025
C) Increased nitrates
Rationale:The nurse would expect the urinalysis of a client with a urinary tract infection to have increased nitrates. Glucose and protein are not normal findings and would require follow-up. Specific gravity of 1.025 is within normal limits; solid formations in the urine suggest calculi.
One form of renal tubular acidosis (RTA) results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of which electrolyte?
A) Potassium
B) Glucose
C) Sodium
D) Hydrogen
C) Sodium
Rationale:One type of RTA results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of sodium ions with decreased elimination of hydrogen and potassium ions. Glucose is not an electrolyte
Several clients in clinic today are reporting urinary signs/symptoms. Which reported manifestation(s) leads the health care provider to suspect acute pyelonephritis? Select all that apply.
A) Abrupt onset of fever and chills
B) Urinary urgency and frequency
C) Flank pain in the back
D) Heart palpitations
E) Shortness of breath
A) Abrupt onset of fever and chills
B) Urinary urgency and frequency
C) Flank pain in the back
Rationale:Acute pyelonephritis tends to present with an abrupt onset of chills, high fever, and an ache or tenderness in the flank area of the back. Lower urinary tract symptoms–dysuria, frequency, and urgency–also are common. Nausea and vomitting may occur along with abdominal pain. Chest pain and shortness of breath is not associated with acute pyelonephritis.
A nurse is caring for a child with Wilms tumor, stage I. Which statements are true regarding this diagnosis? Select all that apply.
A) The tumor has undergone hematogenous metastasis, most commonly involving the lung.
B) The tumor is limited to the kidney and can be excised with the capsular surface intact.
C) Prognosis is good with treatment.
D) Prognosis is poor even with treatment.
B) The tumor is limited to the kidney and can be excised with the capsular surface intact.
C) Prognosis is good with treatment.
Rationale:Long-term survival rates have increased to 90% for Wilms tumor stages I through III. The tumors usually are staged using the National Wilms’ Tumor Study Group classification: stage I tumors are limited to the kidney and can be excised with the capsular surface intact.
A client diagnosed with Goodpasture syndrome would require which therapy to remove proteins and autoantibodies from the system?
A) Renal transplant
B) Intravenous calcium
C) Plasmapheresis
D) Kidney removal
C) Plasmapheresis
Rationale:Plasmapheresis is used to filter the blood for removal of proteins and the circulating anti-GBM antibodies. Renal transplantation would return the kidneys to normal function, but this is the extreme of treatment. The other options would not produce the necessary treatment outcomes
A 34-year-old woman presents with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in her lower back. She is also experiencing dysuria, urinary frequency, and a feeling of urgency. Her partner states that she has been very tired the last few days and that she looked like she may have the flu. What is the most likely diagnosis?
A) Renal cell carcinoma
B) Acute pyelonephritis
C) Acute renal failure
D) Renal calculi
B) Acute pyelonephritis
Rationale:Acute pyelonephritis tends to present with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in the loin area of the back that is unilateral or bilateral. Lower urinary tract symptoms, including dysuria, frequency, and urgency also are common. There may be significant malaise, and the person usually looks and feels ill. Nausea and vomiting may occur along with abdominal pain. Cancer, kidney stones, and acute renal failure have different presentations
The nurse is planning care for a client with a urinary tract obstruction. The nurse includes assessment for which possible complication?
A) Polyuria
B) Decreased blood pressure
C) Diluted urine
D) Increased blood pressure
D) Increased blood pressure
Rationale:Urinary tract obstruction can lead to hypertension related to increased renin secretion. The urine output would be decreased and not diluted.
Which factor contributes to the development of polycystic kidney disease?
A) A reduction in prerenal blood flow to the kidneys
B) Enlargement in the basement membrane of the kidney
C) Hereditary mutations in polycystin I and II
D) Multiple recurrent urinary tract infections
C) Hereditary mutations in polycystin I and II
Rationale:Polycystic kidney disease is typically related to dominant or recessive hereditary mutations in polycystin. The other options are related to urinary tract infections. Some drugs, such as diuretics, high-molecular-weight radiocontrast media, the immunosuppressive drugs cyclosporine and tacrolimus, and the NSAIDs can cause acute prerenal failure by decreasing renal blood flow.
Wilms tumor is a tumor of childhood. It is usually an encapsulated mass occurring in any part of the kidney. What are the common presenting signs of a Wilms tumor?
A) Abdominal pain and diarrhea
B) Hypotension and a large abdominal mass
C) Vomiting and oliguria
D) Large asymptomatic abdominal mass and hypertension
D) Large asymptomatic abdominal mass and hypertension
Rationale:The common presenting signs of a Wilms tumor are a large asymptomatic abdominal mass and hypertension. The tumor is often discovered inadvertently, and it is not uncommon for the mother to discover it while bathing the child. Some children may present with abdominal pain, vomiting, or both. Hypotension, oliguria, and diarrhea are not common presenting signs of a Wilms tumor.
A nurse is caring for a client diagnosed with nephrotic syndrome. The nurse is aware that the client may manifest which of the following? Select all that apply.
A) Hyperalbuminemia
B) Massive proteinuria (>3.5 g/day)
C) Generalized edema
D) Lipiduria
E) Hyperlipidemia
B) Massive proteinuria (>3.5 g/day)
C) Generalized edema
D) Lipiduria
E) Hyperlipidemia
Rationale:Nephrotic syndrome is characterized by massive proteinuria (≥3.5 g/day in adults) and lipiduria (e.g., free fat, oval bodies, fatty casts), along with an associated hypoalbuminemia (<3 g/dL [30 g/L]), generalized edema, and hyperlipidemia. The nephrotic syndrome is not a specific glomerular disease but a constellation of clinical findings that result from an increase in glomerular permeability and loss of plasma proteins in the urine.
A nurse’s neighbor is experiencing some odd symptoms, and asks the nurse about them. The neighbor states having blood in the urine intermittently and thinks there is a lump in the back (where kidney is located). What advice is most appropriate for the nurse to relay to this neighbor?
A) “Do you think you might have a kidney infection?”
B) “Try drinking more water and see if the symptoms go away.”
C) “See if your health care provider will prescribe some antibiotics for you.”
D) “Make an appointment with your health care provider immediately.”
D) “Make an appointment with your health care provider immediately.”
Rationale:Kidney cancer is largely a silent disorder during the early states. Presenting features include hematuria, flank pain, and presence of a palpable flank mass. The tumor may reach considerable size before it is detected. Urinary tract infections may cause hematuria and drinking more water may help along with antibiotics. However, palpable lumps must always be checked by the health care provider.
Which clinical manifestations would you expect to see in an infant diagnosed with autosomal recessive polycystic kidney disease (ARPKD)?
A) Gross hematuria and massive generalized edema
B) Bilateral flank masses and impaired lung development
C) Ascending urinary tract infection and vomiting
D) Elevated systemic blood pressure and severe pain
B) Bilateral flank masses and impaired lung development
Rationale:Clinical manifestations of the typical infant with ARPKD include bilateral flank masses, accompanied by severe renal failure, signs of impaired lung development, and variable degrees of liver fibrosis and portal hypertension. Potter facies and other defects associated with oligohydramnios may be present. Hypertension is usually noted within the first few weeks of life and is often severe.
A nurse is caring for a client who has a recent history of passing calcium urinary stones. Which of the following is a priority nursing consideration for this client?
A) Bed rest
B) Bowel elimination
C) Hydration
D) Skin care
C) Hydration
Rationale:A major goal of treatment in people who have passed kidney stones or have had them removed is to prevent their recurrence. Adequate fluid intake reduces the concentration of stone-forming crystals in the urine and needs to be encouraged.
A school nurse is teaching a group of fourth-grade girls about personal hygiene. Important teaching points aimed at reducing the incidence of urinary tract infection (UTI) include which of the following? Select all that apply.
A) Avoiding bubble baths
B) Careful hand washing
C) Wiping from front to back after a bowel movement
D) Daily tub baths
A) Avoiding bubble baths
B) Careful hand washing
C) Wiping from front to back after a bowel movement
Rationale:Most uncomplicated lower UTIs are caused by Escherichia coli. It is important to wipe from front to back to prevent introducing this pathogen to the urinary tract from the rectal area. It is not necessary to take a daily tub bath. Bubble baths can cause urinary irritation. Careful hand washing helps to reduce the introduction of pathogens to the urinary tract.
